Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
J Allergy Clin Immunol Pract. 2019 Feb;7(2):641-648.e1. doi: 10.1016/j.jaip.2018.07.036. Epub 2018 Aug 18.
Although asthma is associated with impaired lung immunity, it is unclear whether asthma affects the risk of active tuberculosis (TB). Because the upper and lower airways are immunologically related, sinonasal disease may also modify susceptibility to TB disease.
To evaluate whether asthma and sinonasal disease prospectively modulate the risk of active TB in the Singapore Chinese Health Study.
In this population-based prospective cohort, we recruited 63,257 Chinese adults aged 45 to 74 years from 1993 to 1998 in Singapore, and conducted follow-up I interviews among 52,325 surviving participants from 1999 to 2004. Data on self-reported history of physician-diagnosed sinonasal disease were collected at baseline, and data on asthma and chronic bronchitis were collected at follow-up I interviews. Active TB cases were identified by linkage with the National TB Notification Registry through December 2014. Multivariable Cox proportional hazards regression models were used to estimate the risk of active TB.
During a mean follow-up of 17 years from recruitment, there were 1249 cases of active TB, and among them, 678 cases were diagnosed in the 12-year period from follow-up I interviews. We observed reduced risk of active TB in those with a history of asthma at follow-up I (hazard ratio [HR], 0.55; 95% CI, 0.32-0.93) or sinonasal disease at baseline (HR, 0.59; 95% CI, 0.36-0.95). Conversely, history of chronic bronchitis was not associated with risk of TB (HR, 0.95; 95% CI, 0.68-1.31).
Asthma or sinonasal disease may modulate immunological response to reduce the incidence of active TB in the adult population.
尽管哮喘与肺部免疫受损有关，但尚不清楚哮喘是否会增加活动性肺结核（TB）的风险。由于上、下呼吸道在免疫学上相互关联，鼻-鼻窦疾病也可能改变对结核病的易感性。
评估在新加坡华人健康研究中，哮喘和鼻-鼻窦疾病是否前瞻性地调节活动性 TB 的风险。
在这项基于人群的前瞻性队列研究中，我们于 1993 年至 1998 年在新加坡招募了 63257 名年龄在 45 至 74 岁的中国成年人，并在 1999 年至 2004 年期间对 52325 名幸存参与者进行了随访 I 访谈。在基线时收集了自我报告的经医生诊断的鼻-鼻窦疾病史的数据，在随访 I 访谈时收集了哮喘和慢性支气管炎的数据。通过与国家结核病通报登记处的链接，截至 2014 年 12 月，确定活动性 TB 病例。使用多变量 Cox 比例风险回归模型估计活动性 TB 的风险。
在招募后的 17 年平均随访期间，有 1249 例活动性 TB，其中 678 例在随访 I 访谈后的 12 年期间诊断。我们观察到，在随访 I 时有哮喘史（HR，0.55；95%CI，0.32-0.93）或基线时有鼻-鼻窦疾病史（HR，0.59；95%CI，0.36-0.95）的人，患活动性 TB 的风险降低。相反，慢性支气管炎史与 TB 风险无关（HR，0.95；95%CI，0.68-1.31）。
哮喘或鼻-鼻窦疾病可能调节免疫反应，降低成年人群中活动性 TB 的发病率。
